The Importance of Serial Time Point Quantitative Assessment of Cardiac Troponin I in the Diagnosis of Acute Myocardial Damage.

OBJECTIVE: The present study was aimed to establish a threshold value for cardiac troponin I (cTnI) for nonacute coronary syndrome (ACS) participants from the local population and also to determine the importance of serial time point estimation of cTnI in acute myocardial infarction (AMI), non-ST-elevated MI (NSTEMI), and unstable angina cases. METHODS: The present study included 194 cases, admitted in ICCU with the complaint of anginal pain; 31 were diagnosed with AMI with typical electrocardiography (ECG) changes; whereas, 48 cases were diagnosed with NSTEMI. The latter group of cases was selected for the time point study of cTnI release at 0-4 h, 6-12 h, 72 h, and 144 h of admission. cTnI levels were assessed using the Abbott ARCHITECT i1000SR system. RESULTS: ACS was clinically ruled out in 98 cases, and cTnI level for them was used to decide cTnI threshold for the non-ACS group. cTnI level was checked in 17 cases of unstable angina. The threshold value of cTnI for non-ACS participants was 0.1 ng/ml and can be considered as cut-off value for the regional population. The data suggested that the peak of cTnI levels in most of the AMI cases reached during 6-12 h. The cTnI levels were lower than 0.1 ng/ml, and no significant change in ECG was noticed in 17 cases of unstable angina. CONCLUSION: The present study suggested that the repeat of cTnI assay after 4-6 h of admission is required if the initial value is <3 ng/ml.

Pocket carried ultrasound: its usefulness in clinical practice--a pilot study.

AIMS: To assess the diagnostic potential of the latest and smallest pocket carried ultrasound (PCU) in both normal and diseased hearts, to compare its imaging quality and information provided with a high end standard equipment (HSE), and how quickly a clinically meaningful information could be obtained. METHODS: 61 consecutive unselected patients, during the five days referral, formed the study material. 41 patients were outpatient referrals and 20 were bed side studies in either emergency room or intensive care units. Their mean age was 47 years. Every patient underwent two echocardiographic studies, first by the PCU and then followed by a detailed study with HSE. Standard echo planes were scanned and both 2- dimensional and color flow mapping studies were performed. RESULTS: An interpretable scan by Hand carried ultrasound (HCU) was obtained in 57/61 patients. In only 3 cases mild LVH and mild cardiomegaly was missed by HCU, mainly because linear dimensions were not taken with HCU. In all other cases there was agreement between the two examinations which included cases with regional wall motion abnormalities (RWMA), pericarditis, valvular lesions etc. Evaluation of LV ejection fraction, whether normal or deranged, was correctly evaluated in 55/61 patients by both echo techniques. All 3 cases of cardiac murmur were correctly evaluated by HCU which included one case of mitral and tricuspid stenosis. HCU studies changed the management strategies of 2 cases, 1 showing RWMA which necessitated immediate intervention and 1 case of COPD which was diagnosed as dilated cardiomyopathy. The imaging quality of HCU as obtained on LCD screen was well comparable with HSE. The same applied to color flow mapping. The main advantage of HCU was a quick response time in emergency cases due to its easy portability. Moreover the time taken to get meaningful diagnostic information was 5 mins. and 30 secs. CONCLUSION: The pocket held scanner is a substantial development in clinical decision making in a tertiary cardiac centre. It provides a rapid and accurate method in identifying patients both with normal and diseased hearts, thereby influencing their disposal both in OPD and emergency areas.

Multidisciplinary Consensus Document on the Management of Uncontrolled Hypertension in India.

Cardiovascular disease is predicted to be the largest cause of death and disability in India by 2020. Hypertension (HT), one of the main contributing factors, presents a significant public health burden. Inability to achieve adequate blood pressure (BP) control results in uncontrolled hypertension (UHT). The prevalence of UHT is high in India, with only about 9-20% of patients achieving target BP goals. Presently, there are no guidelines specific to UHT, which if left uncontrolled can lead to resistant HT, chronic kidney disease and other complications of HT. A multidisciplinary panel, comprising of specialists in cardiology, nephrology and internal medicine, was convened to address the diagnosis and management of UHT in the Indian population. The panel identified key points concerning UHT and discussed management recommendations in the Indian clinical setting.